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12/5/2012
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Harry P. Hagel, RPh, MS
December 5, 2012
• Funded by the Community Pharmacy Foundation in March 2011
• Project Objectives
- Facilitate rural pharmacy integration into emerging health care models
- Identify opportunities for community pharmacy collaboration
- Provide tools/resources for rural pharmacies
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• Learn how pharmacists can help improve health care quality and patient safety.
• Utilize rural health survey results related to rural health priorities and pharmacy service gaps.
• Learn how to identify potential opportunities for rural health collaboration with community pharmacies and pharmacists.
• Aging rural population and more chronic health conditions
• Pharmacists may be one of only a few health care providers in a community
• Pharmacists can improve medication use, safety and outcomes
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• Patient health – Self-treatment and non-prescription medications
– Referral to care
– Medication use
• Provider education/collaboration – MD, DVS, DDS
• Local economy – Direct/Indirect sales revenue, taxes
– Migration of other business and services
• 7,455 independently owned rural pharmacies in the United States (2007 data)
– 2,019 only pharmacy in their community and 1,044 are located at least 10 miles from the next nearest pharmacy
• 998 closed, 495 opened between 2006-2008
– 158 closures were the only pharmacy servicing their community at the time
Source: Rural Policy Research Institute, Policy Brief No. 2007-6
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• Shrinking/Changing prescription payment
– Medicare Part D
– Emerging health delivery systems
• Expanding patient options, requirements and incentives for prescription access
• Workforce trends
– age, gender, disparity
• Ownership transition
• 2-year pre-professional curriculum
• 4-year Pharm.D. professional curriculum
• Individual State licensure required to practice
• Optional:
– General clinical residency training
– Advanced specialty residency training
– Board certifications
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• Major focus of professional education/training
• Often related terms:
– Clinical pharmacy
– Pharmaceutical care
“Improve the safety and efficacy of patient medication use to achieve optimal clinical
outcomes that improve a patient’s quality of life.”
Source: American Pharmacists Association, www.pharmacist.com/mtm
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Measure
Number of
Studies
Percent
Favorable
Blood Pressure 59 84.7%
Cholesterol 54 81.5%
Hemoglobin A1c 36 88.9%
Hospitalization/Readmission 35 51.4%
Length of hospital stay 32 59.4%
ER visits 25 52%
INR / PT / aPTT 20 85%
Mortality 18 72.2%
Body mass index 16 62.5%
Source: Chisholm-Burns MA, et al. Medical Care, 48;10, October 2010
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Safety Measure Number of
Studies
Percent
Favorable
Adverse event 28 78.6%
Adverse drug reaction 15 60%
Medication errors 11 81.8%
Humanistic Measure
Patient adherence 54 48.1%
Patient knowledge 35 57.1%
Patient satisfaction 41 48.8%
Quality of life 31 38.7%
Source: Chisholm-Burns MA, et al. Medical Care, 48;10, October 2010
• Provide pharmacists insight into the rural health priorities in their State
• Highlight opportunities for collaboration/diversification
• Identify gaps in pharmacy services
• Create awareness and interest
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• Content Development – State Rural Health Annual Reports/Plans – Pharmacist capabilities/scope of practice – Advisory Board review/input
• Completion – Web-based platform – All State Offices of Rural Health
• 68% response rate
• Analysis – State Priorities/Gaps – National Trends
Source: Traynor A, et. al, Minnesota Pharmacist. September/October 2007
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Service Description Percent Low
Availability
Percent High
Importance
Adherence counseling 23.5% 44.1%
Affordable medication access 20.6% 67.6%
Chronic disease management 11.8% 70.6%
Immunizations 5.9% 64.7%
340B pharmacy services 14.7% 32.4%
Hospital drug distribution 11.8% 26.5%
Hospital clinical services 23.5% 29.4%
Medication Therapy Management 23.5% 44.1%
Wellness screening/education 11.8% 38.2%
Description Percent High to
Some Priority
Percent Low to
No Priority
Medication reconciliation 87.9% 12.1%
Medication adherence 81.8% 18.2%
Medication access/affordability 87.9% 12.1%
Narcotic opioid use/abuse 75.8% 24.2%
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Description Percent High to
Some Priority
Percent Low to
No Priority
Care transitions 93.9% 6.1%
Chronic disease management 93.9% 6.1%
Diabetes prevention or management 97.0% 3.0%
Tobacco use/smoking cessation 90.9% 9.1%
Mental health service access/quality 93.9% 6.1%
Women's health (contraception, HPV, etc.) 78.8% 21.2%
Alcohol or drug abuse 81.3% 18.8%
Description Percent High to
Some Priority
Percent Low to
No Priority
Senior care (independent living, medication
use, etc.) 81.8% 18.2%
Sexual health (STD treatment or prevention) 57.6% 42.4%
HIV care/screening and prevention 60.6% 39.4%
Immunizations (any patient group or type) 90.9% 9.1%
Children's health (care access, childhood
immunizations, etc.) 84.8% 15.2%
Oral health 93.9% 6.1%
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Description Percent High to
Some Priority
Percent Low to
No Priority
Primary care provider recruitment/access 100.0% 0.0%
Community pharmacy access 81.8% 18.2%
Pharmacist recruitment/staffing 60.6% 39.4%
Pharmacy service quality 69.7% 30.3%
Enhancing overall quality of care 100.0% 0.0%
Improving access to health services 97.0% 3.0%
Nurse recruitment/staffing 84.8% 15.2%
Description Percent High to
Some Priority
Percent Low to
No Priority
340B drug discount program participation 87.9% 12.1%
Quality Improvement Organizations 96.9% 3.1%
Accountable care organization development 87.5% 12.5%
Patient-centered primary care home
advancement 93.9% 6.1%
Sustaining viability of rural hospitals 97.0% 3.0%
Improving access to emergency medical
services 100.0% 0.0%
Fostering interdisciplinary community
integration 97.0% 3.0%
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High Importance & Low Availability
• Affordable medication access
• Adherence counseling
• Chronic disease management
• Medication Therapy Management
• Wellness screening/education
• Primary care provider recruitment/access
• Enhancing overall quality of care
• Improving access to emergency medical services
• Diabetes prevention or management
• Improving access to health services
• Sustaining viability of rural hospitals
• Nurse recruitment/staffing
• Quality Improvement Organizations
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• Patients
• Pharmacists
• Health-systems
• Communities
• Rural Health Offices
• Colleges of Pharmacy
• State and Federal Policymakers
• Assessment/Planning
• Education/Preparation
• Collaboration/Cooperation
• Adaptation/Innovation
• Regulation/Legislation
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www.rxcaresystems.com/ruralrx3/statesurveys.asp
To complete or update your State survey responses: www.rxcaresystems.com/ruralrx/ruralhealthsurvey.asp
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